New State Survey on Medicaid Managed Care Programs

The Urban Institute recently released a new survey appraising the preparation for Medicaid expansion in many different states as part of the Affordable Care Act (ACA). The analysis discusses how eight individual states, including New York, are changing their programs to accommodate the implementation of the Affordable Care Act. The findings are part of the Robert Wood Johnson Foundation’s State Health Reform Assistance Network tracking program. A full online copy of the survey can be found here.

The study authors note that many states are using Medicaid “managed care” to expand eligibility. For example, as discussed in the report, New York “intends to move non-dual-eligible nursing home patients into managed care.” The goal is to complete the transition by October of this year. New York plans to participate in a special program to help manage care for seniors who are “dual eligible” for both Medicaid and Medicare. This includes many elderly community members. This program is know as the State Demonstrations to Integrate Care for Dual Eligible Individuals.

In addition, as part of the change, New York is switching from a voluntary managed care enrollment to a required one. In the past providers could participate if they chose, but now they cannot. New enrollments requirements mandate managed care participation. Over the long-term, of course, this requirement means that more and more Medicaid participants will be on managed care.

The Urban Institute study also provides a succinct summary of New York’s overall Medicaid Managed Care Program. Of interest to those working on elder law issues, it is explained how the state contracts with different health plans to provide support to certain unique populations with long-term care needs, like those with HIV/AIDS among others.

A summary of the report from The Hill, notes how New York’s Medicaid enrollment is expected to increase by about 23% in the next eight years. This places the state on the lower end of the projected expansion as a raw percentage when compared with other states. However, that is likely because New York already leads the pack with Medicaid enrollees, so there is less room for an increase.

It is important to reiterate that while discussion surrounding Medicaid expansion as part of the AFA has been raging for several years, we are still very early in the implementation process. That means that many different changes are yet to be fully realised. Local seniors and their families with questions about New York Medicaid eligibility or possible changes that may affect them should contact professionals for tailored advice.